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Long-COVID Syndrome? a Study on the Persistence of Neurological, Psychological and Physiological Symptoms

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Long-COVID Syndrome? a Study on the Persistence of Neurological, Psychological and Physiological Symptoms healthcare Article Long-COVID Syndrome? A Study on the Persistence of Neurological, Psychological and Physiological Symptoms Graziella Orrù 1,* , Davide Bertelloni 1, Francesca Diolaiuti 1, Federico Mucci 2 , Mariagrazia Di Giuseppe 1, Marco Biella 1 , Angelo Gemignani 1, Rebecca Ciacchini 1 and Ciro Conversano 1 1 Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Via Savi, 10, 56126 Pisa, Italy; [email protected] (D.B.); [email protected] (F.D.); [email protected] (M.D.G.); [email protected] (M.B.); [email protected] (A.G.); [email protected] (R.C.); [email protected] (C.C.) 2 Department of Biotechnology, Chemistry and Pharmacy, University of Siena, 53100 Siena, Italy; [email protected] * Correspondence: [email protected]; Tel.: +39-050-993-654 Abstract: Background: Emerging aspects of the Covid-19 clinical presentation are its long-term effects, which are characteristic of the so-called “long COVID”. The aim of the present study was to investigate the prevalence of physical, psychological, and sleep disturbances and the quality of life in the general population during the ongoing pandemic. Methods: This study, based on an online survey, collected demographic data, information related to COVID-19, sleep disturbances, and quality of life data from 507 individuals. The level of sleep disturbances and quality of life was assessed through the Insomnia Severity Index (ISI) and the EuroQol-5D (EQ-5D), respectively. Citation: Orrù, G.; Bertelloni, D.; Results: In total, 507 individuals (M = 91 and F = 416 women) completed the online survey. The Diolaiuti, F.; Mucci, F.; Di Giuseppe, main symptoms associated with “long COVID” were headache, fatigue, muscle aches/myalgia, M.; Biella, M.; Gemignani, A.; articular pains, cognitive impairment, loss of concentration, and loss of smell. Additionally, the Ciacchini, R.; Conversano, C. p Long-COVID Syndrome? A Study on subjects showed significant levels of insomnia ( < 0.05) and an overall reduced quality of life the Persistence of Neurological, (p < 0.05). Conclusions: The results of the study appear in line with recent publications, but uncer- Psychological and Physiological tainty regarding the definition and specific features of “long COVID” remains. Further studies are Symptoms. Healthcare 2021, 9, 575. needed in order to better define the clinical presentation of the “long COVID” condition and related https://doi.org/10.3390/ targeted treatments. healthcare9050575 Keywords: long COVID; long-haul COVID; quality of life; insomnia; COVID-19 Academic Editor: Roberta Ferrucci Received: 30 March 2021 Accepted: 10 May 2021 1. Introduction Published: 13 May 2021 As of March 2021, it appears no longer necessary to repeat how and to what extent the COVID-19 pandemic has plagued humanity in the last year, being responsible for morbidity Publisher’s Note: MDPI stays neutral and mortality levels with few precedents in the recent history [1–3]. During the first weeks, with regard to jurisdictional claims in in which we were all unprepared to face such a disaster, our attention had necessarily to be published maps and institutional affil- iations. directed towards the negative and significant impact of the ongoing infection. Although most individuals initially developed a mild COVID-19 infection that did not require hospitalization [4], countless individuals needed to be admitted to intensive care units, experiencing life-threatening symptoms. A growing number of studies have reported a set of neurological complications [5–8] associated with COVID-19 and significant Copyright: © 2021 by the authors. psychopathological symptoms related to intense distress (i.e., post-traumatic stress disorder, Licensee MDPI, Basel, Switzerland. secondary traumatic stress, complicated grief and anxiety, amongst others) in the general This article is an open access article population and health-care workers [9–15]. This corollary of symptoms is particularly distributed under the terms and conditions of the Creative Commons exacerbated within frontline health-care workers, a category of professionals who are at a Attribution (CC BY) license (https:// significant risk of experiencing high levels of burnout and compassion fatigue compared to creativecommons.org/licenses/by/ the general population [16–18] and are in contact with individuals at the final stage of life 4.0/). in their clinical practice [19]. Healthcare 2021, 9, 575. https://doi.org/10.3390/healthcare9050575 https://www.mdpi.com/journal/healthcare Healthcare 2021, 9, 575 2 of 15 Emerging aspects of COVID-19 clinical presentation are the long-term effects, which, in the absence of any formally agreed definitions, characterize the so-called “long-COVID” or “long-haul COVID” described in recent international journals [20–22]. As highlighted by Marshall [20] in Nature, “People with more severe infections might experience long-term damage not just in their lungs, but in their heart, immune system, brain and elsewhere”. In this context, several patients are experiencing a vast variety of symptoms that persist after recovery, despite a negativized pharyngeal swab [23–25]. In order to track possible long-term effects caused by COVID-19 with the aim to im- prove health outcomes, a new initiative has been established in the United Kingdom, called the Post-Hospitalisation COVID-19 Study (PHOSP-COVID) (https://www.phosp.org/, accessed date 2 April 2021). PHOSP-COVID is a consortium of leading researchers and clin- icians which aims to recruit 10,000 patients for a year, with the aim to analyze clinical factors derived from clinical assessments and gain a comprehensive understanding of COVID-19 long-term effects along with the patients’ medical, psychological, and rehabilitation needs, enabling, in this way, their full recovery. Long COVID may incorporate the following symptoms: (i) cardiovascular (i.e., chest tightness, chest pain, palpitations); (ii) respiratory (i.e., breathlessness, cough); (iii) neuro- logical (i.e., stroke, encephalopathy, meningoencephalitis, seizures, cognitive impairment, headache, sleep disturbance, dizziness, delirium); (iv) gastrointestinal (i.e., abdominal pain, nausea, diarrhea, anorexia and reduced appetite); (v) musculoskeletal (i.e., joint pain, muscle pain); (vi) inflammatory (i.e., fatigue, fever, pain); (vii) generalized and aspecific (i.e., skin rashes, tinnitus, earache, sore throat, dizziness, loss of taste and/or smell) (NICE guideline, 2020). Moreover, a few studies also outlined how the sleep patterns change in patients with long COVID, with a drastic reduction in sleep quantity and quality [26–28]. In a clinical research conducted by Kokou-Kpolou and colleagues in 2020 [29], the authors analyzed the prevalence of insomnia in the general population and its contributing fac- tors in a sample of French individuals. According to the aim of the study, participants underwent a qualitative sleep assessment based on the Insomnia Severity Index (ISI), and the study confirmed that COVID-19-related worries and loneliness may represent the major contributing factor to clinical insomnia. All these mentioned symptoms can cause a dramatic decrease of the quality of life [30,31]. In the recent literature, when symptoms persist beyond 3 or 12 weeks, the resulting pathological conditions have been defined as “long COVID/post-acute COVID” and “chronic post-COVID syndrome”, respectively. Both these conditions are characterized by a multi- system syndrome that requires an integrated multidisciplinary intervention capable of dealing with both the residual physical symptoms and the consequent social discomforts and mental disorders [32]. In Italy, most COVID-19 patients presented evident symptoms (71.4% of the 31,845 confirmed cases as of 3 June 2020) related to the long-COVID condition. However, there is still limited evidence of this as yet, indeed there are no precise data regarding the persistence of symptoms or its long-term consequences in the weeks and months following the remission period [33]. Consequently, little is known or published on the supposed long-COVID syndrome and its long-term consequences. Some studies have reported that fatigue and headache are the main symptoms displayed by these individuals [25,27,34]. Other clinical studies reported increased sleep-related issues, including insomnia, and a deterioration of the life quality [25,27]. Furthermore, it is also necessary to underline that lung diseases are an established and well-known causes of fatigue [35], and the central nervous origin of post-viral fatigue should also be considered (i.e., inflammatory-mediated and neurocognitive dysfunction) when we analyze long-COVID-related symptoms. The purpose of the present study was to evaluate the physical and psychological health conditions of a representative sample of the Italian population suffering from symptoms related to long COVID. In particular, we focused our attention on the prevalence of physical, Healthcare 2021, 9, 575 3 of 15 psychological, or neurological problems, insomnia, and the level of quality of life in the general population. 2. Materials and Methods 2.1. Participants From 5 February to 15 February 2021, we collected 517 responses from individuals living in Italy through an online survey. Of these, we excluded two respondents younger than 18 years and eight additional individuals who did not give informed consent. The final sample consisted of 507 subjects, composed of 91 men (17.95%)
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